Further memorandum submitted by the Department
for Work and Pensions (MS 01A)

1. INTRODUCTION

1.1 This supplementary memorandum contains
information to answer questions put to the Department, which was
not to hand when the Department's Memorandum was submitted. It
covers:

 Time taken for Incapacity Benefit
examinations.

 Data on claimant complaints.

 Data on customer satisfaction surveys.

 Pay levels for sessional doctors
and doctor shortages.

 Claimants turned away unseen.

2. TIME TAKENFOR EXAMINATIONS

2.1 Improvements to service performance
implemented by Medical Services have included a more flexible
approach to arranging examination sessions, in the interests of
both claimants and doctors. Previously, sessions were of a fixed
duration of 3.5 hours; and were all held during normal working
hours. Doctors are now free to contract for any period of time
they choose. Additional evening and weekend sessions offer both
doctors and claimants greater choice. The duration of sessions
is variable, so it is no longer meaningful to express management
information data in terms of average number of claimants seen
per session.

2.2 Time spent with claimants has not reduced,
although improvements to scheduling have reduced time wasted between
examinations. The average time taken for assessment over the last
six months was 37 minutes, and represents the actual time spent
by the doctor with the claimant, plus the time taken to write
the report. The previously quoted figure of 46 minutes was calculated
differently, by dividing the session duration by the number of
claimants seen. As well as time spent with the claimant and completing
the report, it also included the time taken to preview the case
notes and collect the claimant from the waiting room, as well
as time lost waiting for claimants to arrive. The success of the
"Did Not Attend" project (see paragraph 6.11 of the
main DWP memorandum) means that time lost at examination sessions
will in future be minimised.

2.3 The time required to carry out an appropriate
assessment varies depending on the claimant's disabling condition
and its complexity. Doctors are encouraged to take as much time
as required to provide an accurate assessment. It is not in anyone's
interest to unnecessarily prolong an assessment, or provide an
unnecessarily detailed report.

3. CLAIMANT COMPLAINTS

3.1 Data on claimant complaints is not recorded
by benefit type. Detailed information about the number and category
of complaints for the last three quarters is at Annex 1. Prior
to this, a different system of categorising complaints was used,
so earlier data are not directly comparable.

3.2 There has been a slight decrease in
the overall number of complaints in the last quarter, and a steady
decrease in the number of complaints alleging cultural insensitivity;
the Select Committee had expressed particular concern over the
latter category. All doctors now receive specific training in
multicultural awareness; and any complaint alleging cultural insensitivity
attracts immediate feedback to the doctor concerned, with retraining
if appropriate. The ratio of complaints to examinations carried
out remains well below 1 per cent.

3.3 Actions taken to improve the complaints
system include implementation of targets for timeliness of reply,
and audit of the quality standard of replies by Medical Services.

4. CUSTOMER SATISFACTION
SURVEYS

4.1 Regular customer satisfaction surveys
are carried out. The results of customer satisfaction surveys
over the last year are shown in Table 1.

PERCENTAGE OF CUSTOMERS EXPRESSING THEMSELVES
SATISFIED OR VERY SATISFIED WITH MEDICAL SERVICES

Date

Examination centres

Domiciliary visits

February 2001

96%

96%

March

97%

95%

April

96%

93%

May

98%

95%

June

97%

89%

July

97%

94%

August

96%

95%

September

96%

97%

October

96%

91%

November

96%

95%

December

97%

94%

January 2002

96%

93%

4.2 Customer satisfaction surveys include data on gender,
age, ethnic origin, and special needs. Reports based on these
parameters were produced between August and October 2000. However,
due to the small numbers involved, the reports did not provide
any additional information of value, and were therefore discontinued.
The Department and Medical Services are further investigating
the issue of research into customer satisfaction, to improve on
the present process, including measures which will allow extraction
of statistically valid data on these parameters.

5. PAY LEVELSFOR SESSIONAL
DOCTORS; DOCTOR
SHORTAGES

5.1 Sessional doctors' fees were increased by 3 per cent
in September 2000, and by a further 15 per cent in April 2001.
Since April 2001, fees for sessional doctors have been on a basis
of fee per case instead of a fixed hourly rate. 96 per cent of
existing sessional doctors opted to move onto fee per case; and
all doctors recruited since April 2001 are contracted on a fee
per case basis. When linked with the greater flexibility over
session timing (see paragraph 2.1), the new arrangement offers
doctors the opportunity to earn significantly more from this work
if they want to.

5.2 The new arrangement offers doctors greater flexibility
on the time they wish to devote to this work. It also recognises
and rewards productivity, for example, the doctor who sees an
additional claimant, who might otherwise have had to be sent home
unseen. Although the success of the "Did Not Attend"
project will significantly reduce the need for overbooking, and
hence the risk of claimants being sent home unseen, there will
inevitably still be occasions where a doctor may need to see more
than the planned number of claimants. Different levels of fee
apply to case types of different complexity. There are also minimum
income safeguards, guaranteeing levels of payment if not all the
claimants expected turn up for examination.

5.3 Safeguards are also in place to ensure that medical
quality standards are maintained. Any sustained deviation from
a doctor's normal pattern of working automatically triggers quality
monitoring of the doctor's reports.

5.4 Medical Services have lost a number of doctors through
natural attrition. A major national recruitment campaign for both
employed and sessional doctors has been under way since August
2001, with considerable success. 43 new doctors have already accepted
an appointment as direct employees of SchlumbergerSema, and 28
of these have already started work. Allied to improvements in
use of doctor time, such as more efficient scheduling of examinations,
Medical Services have calculated that they have sufficient resources
to handle current service levels, and anything up to a 10 per
cent increase in current examination volumes.

5.5 There remain areas where there is a general shortage
of doctors. A number of initiatives have been taken to address
this, including financial inducements to doctors recruited in
these areas; and the use of a mobile task force of doctors to
cover areas of shortage.

6. CLAIMANTS TURNED
AWAY UNSEEN

6.1 The target that no more than 3 per cent of claimants
should be sent home unseen was set in June 2001. Performance against
that target is shown in Table 2.

Table 2

PERCENTAGE OF CLAIMANTS TURNED AWAY UNSEEN

Jun 01

July

Aug

Sep

Oct

Nov

Dec

Jan 02

Feb

4.46

4.04

3.76

3.53

3.68

3.19

3.18

3.75

3.61

6.2 Although the target has not yet been met, there was
steady improvement in performance until January 2002, when service
levels slipped. Medical Services are predicting they will meet
the target in March 2002. The success of the "Did Not Attend"
project will enable more effective scheduling, reducing the need
to overbook sessions to compensate for claimants failing to attend,
and therefore reducing the need to turn claimants away unseen.

9 April 2002

Annex 1

COMPLAINT CATEGORIES FOR QUARTER ENDING AUGUST 2001

MSC/Categories

Doctor's
Manner

Content of
Exam

Length of
Exam

Clinical
Findings

Waiting
Times

Admin/
Accom

Others

Expenses

Cultural
Insensitivity

No of
Complaints
Received

Southwest
Birmingham

101

70

7

34

5

24

2

2

1

93

Bristol

73

44

7

25

3

21

0

12

1

83

Cardiff

56

42

6

16

5

10

0

7

1

61

Total

230

156

20

75

13

55

2

21

3

237

South East
Nottingham

35

24

2

8

15

24

0

16

1

79

Sutton/Wembley

163

93

21

35

19

58

7

22

2

170

Total

198

117

23

43

34

82

7

38

3

249

Northern
Bootle

80

48

14

32

14

28

7

13

0

90

Edinburgh

20

11

1

3

0

5

1

7

0

29

Glasgow

47

33

12

34

13

26

1

5

0

77

Leeds

123

83

18

34

10

37

8

9

2

138

Manchester

41

30

6

24

2

10

3

15

0

75

Newcastle

79

66

6

26

25

46

4

12

1

141

Total

390

271

57

153

64

152

24

61

3

550

CRT

24

34

17

20

3

17

1

4

1

70

National Total

842

578

117

291

114

306

34

124

10

1106

Notes:

1. A single complaint may cover more than one category

2. The National Customer Relations Team (CRT) handles
a proportion of complaints directly